Ati Nervous System Meds (Psychotic Disorders)

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antipsychotic first generation (conventional)

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prototype: chlorpromazine (Thorazine)-low potency

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haloperidol (Haldol)-high potency

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antipsychotic 1st gen

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fluphenazine- high potency

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antipsychotic 1st gen

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thiothixene (Navane)-high potency

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antipsychotic 1st gen

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perphenazine- medium potency

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antipsychotic 1st gen

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antipsychotic 1st gen MOA

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blocks dopamine, acetylcholine, histamine, norepinepherine receptors in the brain and periphery
inhibition of psychotic manifestations, believed to be a result of D2 blockade in the brain

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antipsychotic 1st gen Use

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treats acute and chronic psychotic disorders
schizophrenia disorders
bipolar disorder
Tourette's
prevention of nausea/vomiting through blockage of dopamine in CTZ of medulla

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antipsychotic 1st gen adverse

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acute dystonia
parkinsonism
akathisia
tardive dyskinesia
neuroleptic malignant syndrome
anticholinergic effects
neuroendocrine effects
seizures
skin effects
orthostatic hypotension
sedation
sexual dysfunction
agranulocytosis
severe dysrhythmias

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antipsychotic 1st gen contraindications

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coma, severe depression, parkinson's, prolactin-dependent cancer of breast, dementia, kidney disease, and seizure disorder

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antipsychotic 1st gen interactions

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anticholinergics with other anticholinergics will increase anticholinergic effects
alcohol, opioids, and antihistamines have additive CNS depressant effects
levodopa counteracts the effects of antipsychotic meds

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antipsychotic 1st gen administration

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screen for EPS
administer anticholinergics, beta-blockers, and benzodiazipines to control early EPS
may take 2-4 weeks for full effect
take at bedtime to promote sleep and decrease daytime drowsiness

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Antipsychotics 2nd gen (atypical)

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risperidone (Risperdal)

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olanzapine (Zyprexa)

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antipsychotics 2nd gen
low risk of EPS
high risk of for DM, weight gain, dyslipidemia
sedation, orthostatic hypotension, anticholinergic effects

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quetiapine (Seroquel)

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antipsychotic 2nd gen
moderate risk of DM, weight gain, dyslipidemia
cataracts, sedation, orthostatic hypotension, anticholinergic effects

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aripiprazole (Abilify)

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antipsychotic 2nd gen
low or no risk of DM, EPS, weight gain, dyslipidemia, hypotension, and anticholinergic effects
headache, anxiety, insomnia, sedation, and gastrointestinal upset

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ziprasidone (Geodon)

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antipsychotic 2nd gen
low risk of EPS, DM, weight gain and dyslipidemia
sedation, orthostatic hypotension, anticholinergic effects, and rash
ECG changes, QT prolongation may lead to torsades de pointes

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clozapine (Clozaril)

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antipsychotic 2nd gen
first atypical antipsychotic
low risk of EPS
high risk of weight gain, DM, dyslipidemia
agranulocytosis may occur
sedation, orthostatic hypotension and anticholinergic effects

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asenapine (Saphris)

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antipsychotic 2nd gen
low risk of DM, weight gain, dyslipidemia, and anticholinergic
drowsiness, prolonged QT, numbing of the mouth

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lursidione (Latuda)

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antipsychotic 2nd gen
sedation, akathisia, parkinsonism, agitation, anxiety
low risk of DM, weight gain, dyslipidemia

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paliperidone (Invega)

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antipsychotic 2nd gen
high risk of DM, weight gain, dyslipidemia
sedation, prolonged QT interval, orthostatic hypotension, anticholinergic effects, and mild EPS

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Iloperidone (Fanapt)

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antipsychotic 2nd gen
dry mouth, sedation, fatigue, nasal congestion
significant risk for weight gain, prolonged QT interval and orthostatic hypotension
low risk for DM, dyslipidemia, and EPS

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antipsychotic 2nd gen MOA

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blocking serotonin and to a lesser degree, dopamine receptors
also blocks norepinepherine, histamine, acetylcholine receptors

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antipsychotic 2nd gen Use

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schizophrenia
psychotic episodes
psychotic manifestations

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antipsychotic 2nd gen adverse

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new onset of DM or loss of glucose control
weight gain, hypercholesterolemia with increased hypertension and other cardiovascular disease
orthostatic hypotension
anticholinergic effects
agitation, dizziness, sedation, sleep disruption, mild EPS such as tremor

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antipsychotic 2nd gen contraindications

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dementia
all atypical antipsychotics can cause death related to CVA or infection

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antipsychotic 2nd gen interactions

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immunosuppressive meds- avoid with clozapine
alcohol, opioids, and antihistamines-additive CNS depressant
levodopa counteracts effects of antipsychotics by activating dopamine receptors
TCAs, amiodarone and clarithromycin prolong QT interval
barbiturates and phenytoin (Dilantin) decrease levels of aripraprazole, quetiapine, and ziprasidione
fluconazole increases levels of aripiprazole, quetiapine, and ziprasidone

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antipsychotic 2nd gen admin

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lurasione with food to increase absorption

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antipsychotic 2nd gen effectiveness

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improvement of psychotic manifestations
ability to perform ADLs
ability to interact socially with peers
improvement of sleeping and eating patterns